AppealClock.You will not miss your deadline

Situation · surprise & balance billing

You got a surprise bill. Most of them are now illegal.

Since 2022, the No Surprises Act bans most surprise balance bills: emergency care (any hospital), out-of-network doctors who treated you at an in-network facility, and air ambulances. You owe only your normal in-network cost-sharing. The big exception: ground ambulances are not covered by the federal law.

Protected situations

  1. Emergency room care — anywhere, any hospital, no prior authorization required. Protected.
  2. Out-of-network specialists at an in-network facility — the anesthesiologist you never chose, the assistant surgeon you never met. Protected.
  3. Air ambulance — protected, in-network rates apply.
  4. Uninsured or self-pay? You're owed a good-faith estimate. If the bill runs more than $400 over it, you can file a federal patient-provider dispute for $25.
  5. Ground ambulance — the gap. Federal law doesn't protect you; about a third of states have their own rules. Dispute, negotiate, and use hospital financial assistance.
  6. If a protected bill arrives anyway — don't pay it. Tell the provider it violates the No Surprises Act, then complain to CMS at 1-800-985-3059. It's free.

Fight it in minutes, free

Translate your denial, draft the letter, and let AppealClock watch every deadline on the ladder. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

Can an ER bill me extra for being out of network?
No. Emergency care is protected by the No Surprises Act regardless of network — you owe only your normal in-network cost-sharing, and coverage must be based on your symptoms, not your final diagnosis.
Are ground ambulances covered by the No Surprises Act?
No — ground ambulances are the law's biggest gap, though some states have their own protections. Air ambulances ARE covered. For a ground ambulance bill: dispute it in writing, ask for the itemized bill, negotiate, and check state rules.
What if I'm uninsured and the bill is way over the estimate?
If the final charges are more than $400 above your good-faith estimate, you can file a patient-provider dispute with HHS for a $25 fee, and the bill is frozen while it's decided.